US20110153018A1 - Method and Apparatus for Graft Fixation - Google Patents
Method and Apparatus for Graft Fixation Download PDFInfo
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- US20110153018A1 US20110153018A1 US13/036,781 US201113036781A US2011153018A1 US 20110153018 A1 US20110153018 A1 US 20110153018A1 US 201113036781 A US201113036781 A US 201113036781A US 2011153018 A1 US2011153018 A1 US 2011153018A1
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- Prior art keywords
- tunnel
- soft tissue
- fastener
- flexible strand
- tissue replacement
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
- A61B17/17—Guides or aligning means for drills, mills, pins or wires
- A61B17/1714—Guides or aligning means for drills, mills, pins or wires for applying tendons or ligaments
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
- A61B17/17—Guides or aligning means for drills, mills, pins or wires
- A61B17/1739—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body
- A61B17/1764—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body for the knee
Definitions
- the present invention relates to endoscopic soft tissue replacement fixation. More particularly, the present invention relates to an apparatus and a method to reconstruct an anterior cruciate ligament with soft tissue replacements within a femoral tunnel.
- the knee joint is frequently the object of injury and is often repaired using arthroscopic surgical procedures.
- An example of such arthroscopic surgical procedure is the replacement of anterior cruciate ligaments of the knee. The tearing of these ligaments is common in sports activities such as football or skiing.
- fascia lata soft tissue replacements are flexible strands which are affixed to a threaded stud and turned into the femoral tunnel. Unfortunately, this procedure may result in the soft tissue replacement being wrapped upon itself during insertion.
- Hamstring soft tissue replacements are also currently fixed over a screw in the tibial tunnel and fixed on the lateral femur. This technique requires the femoral tunnel to completely penetrate the femur.
- fixation of the soft tissue replacement on the femoral side requires a large incision.
- An apparatus including a member that acts as a flexible strand insertion and guide rod is used to increase the simplicity and effectiveness of a soft tissue implant procedure.
- the member inserts a flexible strand, which has been preloaded onto the insertion rod, into a blind tunnel formed in a bone structure and provides a guide for first and second drill points or bits.
- the member may be removed with the flexible strand already positioned in place to pull an implant into the blind tunnel over the first drill point and adjacent the second drill point.
- the second drill point is then removed, allowing the implant to be easily pulled over the first drill point.
- a cross or set pin is then pulled after the drill point into the drill hole to lock the implant in place.
- a first embodiment includes an apparatus to position a flexible strand in a tunnel, having a diameter, formed in a bone while performing a surgery.
- the apparatus comprises a guide member extending along a first axis and having a first end and second end.
- the guide member includes a guide portion defining an area, extending from the first end and along the first axis.
- the guide portion includes a first leg and a second leg, the first leg and the second leg define a slot disposed therebetween, wherein the slot defines a first plane.
- the first leg further defines a first groove and the second leg defines a second groove; wherein the first groove extends along a distal end of the first leg and along a length of the first leg and the second groove extends along a distal end of the second leg and along a length of the second leg.
- the first groove and the second groove are adapted to receive the flexible strand.
- the apparatus further has a second guide member fixed parallel to the first member.
- the second member has a pair of guide holes configured to guide first and second adjacent drill points.
- a second embodiment of the apparatus includes an apparatus to place a flexible strand in a tunnel, having a diameter, formed in bone while performing a surgery.
- the apparatus comprises a first member having a first end and a second end spaced apart.
- the first end defines a slot, adapted to guide an instrument, wherein the slot lies in a first plane.
- the first end further defines a groove, wherein the groove lies in a second plane.
- the first plane and the second plane intersect.
- a second member having a first end and a second end, the second member defines first and second passages positioned adjacent the first end.
- the first member extends adjacent to the second end of the second member; wherein the first end of the first member and the passage are generally aligned.
- the apparatus allows a method of performing an implant procedure.
- a method of surgically implanting a soft tissue replacement for attaching two bone members comprises inserting an insertion rod having a flexible strand pre-loaded on the insertion rod into a first tunnel. Next, forming second and third tunnels transverse and through the first tunnel and the insertion rod with a tool bit. Next, retaining the flexible strand within the first tunnel. The method also includes removing the insertion rod from the second tunnel and retracting the flexible strand.
- FIG. 1 is a perspective view of the bone insertion rod affixed to a U-Guide
- FIG. 2 is a perspective view of bone insertion rod not affixed to the U-Guide
- FIG. 3 is an exemplary view of a knee prepared for insertion of the insertion rod
- FIG. 4 is a perspective view of the insertion rod and U-Guide inserted into the tibia and femur tunnels with the flexible strand in place;
- FIG. 5 is a view of the U-Guide and insertion rod in place with a pair of K-Wire Drill Points forming a transverse tunnel;
- FIG. 6 is perspective view of the first and second K-Wire Drill Points with the flexible strand affixed to a soft tissue replacement and draped over the second K-Wire Drill Point;
- FIG. 7 depicts the second K-Wire Drill Point removed with the soft tissue replacement draped over the first K-Wire Drill Point
- FIG. 8 is a perspective view of the soft tissue replacement pulled over the K-Wire and out through the tibial tunnel;
- FIG. 9 is a perspective view of the soft tissue replacement in place and the ACL Cross Pin set in place in the transverse tunnel in the femur.
- FIG. 10 is a view of the knee with an ACL replacement having its free ends affixed to the tibia and the femoral end affixed over the ACL Cross Pin.
- FIG. 11 represents the insertion of bone cement into the femoral tunnel shown in FIG. 1 ;
- FIG. 12 is a view of a knee joint having a prepared femur accordance to the teachings of an embodiment the present invention.
- FIGS. 12 and 13 represent the insertion of the soft tissue into a femoral tunnel shown in FIG. 10 ;
- FIGS. 13 and 14 represent the insertion of a soft tissue implant according to the teachings of a second embodiment of the invention.
- FIG. 15 represents the insertion of bone cement into the femoral tunnel shown in FIG. 12 ;
- FIGS. 16 a through 16 d represent the insertion of a soft tissue implant according to another embodiment of the invention.
- FIGS. 17 a and 17 b represent side and end views of a soft tissue implant according to the teachings of the present invention.
- FIG. 18 represents the insertion of soft tissue using a soft tissue implant shown in FIGS. 17 a and 17 b;
- FIGS. 19 a and 19 b represent alternate soft tissue implants according to another embodiment of the present invention.
- FIG. 20 represents an alternate method of coupling an ACL into a femoral tunnel
- FIGS. 21 a and 22 represent an alternate method of coupling an ACL into a femoral tunnel.
- a guide apparatus 10 which may be generally U-shaped, includes an L-shaped retaining bar or L-guide 12 that includes two portions or legs, a first portion 14 and a second portion 16 , that is substantially perpendicular to the first portion 14 .
- the first portion 14 defines a first guide section 18 and a second guide section 19 , formed transversely through the first portion 14 .
- the guide section may be passage through or transverse to the first portion 14 such as a bore wherein the guide section ledge would be a bore ledge.
- a pair of set screws 20 and 21 are provided to create a locking mechanism for the guide sections 18 and 19 .
- the second portion 16 defines a bore 22 formed transversely through the second portion 16 .
- a set screw 24 is also provided to create a locking mechanism for the bore 22 .
- the L-guide 12 is shown in an L-shape, however, it will be understood the L-guide 12 may be any appropriate form. Generally, however, the axes defining the guide section 18 and the bore 22 are orthogonal. Therefore, the first and second axis A and B of the guide section 18 should intersect the second axis E of the bore 22 at a right angle.
- the insertion rod 26 is adjustably held in the bore 22 and locked in place with the set screw 24 .
- the insertion rod 26 includes a body portion 28 .
- the body portion 28 is substantially cylindrical and formed around a longitudinal axis C.
- the body portion 28 which is generally a solid, may also taper towards the guide portion 36 (described herein).
- the body portion 28 may include depth indicia 29 to give a visual indication of the depth of the insertion rod 26 into a patient.
- an L-Guide engaging portion 30 Extending from a first end of the body portion 28 is an L-Guide engaging portion 30 which includes a notch or projection 32 that is received in the second portion 16 of the L-Guide 12 to ensure proper orientation of the insertion rod 26 to the L-Guide 12 .
- the notch 32 on the insertion rod 26 is keyed to be received on to a portion of the second portion 16 .
- the insertion rod 26 further includes a collar 34 , to ensure that the insertion rod 26 is held at a predetermined depth in the L-Guide 12 and to further ensure proper orientation of the insertion rod 26 relative to the L-Guide 12 .
- a guide portion 36 extends from a second end of the body portion 28 .
- the guide portion 36 includes two generally parallel legs 38 and 40 and a shoulder 41 .
- Each leg 38 , 40 extends from the body portion 28 along axis C, though offset therefrom.
- the two legs 38 , 40 define a slot 42 , where the slot 42 extends substantially the distance of the two legs 38 , 40 and meet at the shoulder 41 .
- Also formed in each of the legs 38 , 40 is a flexible strand groove 44 .
- the flexible strand groove 44 may be any appropriate depth, but exemplary is substantially equal in depth to the diameter of a cord or flexible strand thread or suture to be used with the apparatus 10 .
- the insertion rod 26 may be any desired length.
- the distance between the collar shoulder 34 and the shoulder 41 is equal to the distance between a first end of the first portion 14 , generally represented by line D, and the guide section 19 .
- the guide section ledge 19 and the slot 42 are generally equidistant from the second portion 16 . Therefore, any instrument received through the guide section 19 would remain substantially parallel to the second portion 16 when it passed through the slot 42 .
- the flexible strand groove 44 is placed orthogonally to the slot 42 so that a cord, such as a flexible strand, may be placed in the flexible strand groove 44 to form an enclosed passage for any device that may be placed through the slot 42 .
- a device such as a K-Wire (described herein), when inserted through the slot 42 has a flexible strand looped over the K-Wire.
- the flexible strand groove 44 may be formed at any orientation relative to the slot 42 as long as a flexible strand placed in the flexible strand groove 44 will overlay the slot 42 .
- the notch 32 ensures that the insertion rod 26 is properly oriented with the L-Guide member 12 of the U-guide apparatus 10 .
- the slot 42 is preferably aligned with the guide sections 18 and 19 .
- the set screw 24 tightens against the L-Guide engaging portion 30 to ensure that the insertion rod 26 does not move during a surgical procedure. Also, this ensures the proper keyed fit of the notch 32 into the second portion 16 so that the guide section 18 and the slot 42 are properly aligned. This ensures that the instrument received through the apparatus 10 is aligned. It will be understood, however, that any appropriate means may be used to secure the insertion rod 26 to the L-Guide member 12 of the apparatus 10 .
- FIGS. 3-11 an exemplary method for using the apparatus 10 , including the insertion rod 26 is described. It will be understood that although the apparatus 10 is described in the use of an Anterior Cruciate Ligament (ACL) replacement, any appropriate surgery may be performed with the apparatus 10 which would require its attributes.
- ACL Anterior Cruciate Ligament
- a knee 50 generally includes at least a tibia 52 and a femur 54 surrounded by soft tissue 55 .
- the knee 50 is initially prepared by forming a tibial tunnel 56 and a femoral tunnel 58 which are substantially in line with one another such that a straight and solid object could engage both the tibial tunnel 56 and the femoral tunnel 58 without a substantial amount of stress when the knee is placed in flexion between about 30 degrees and 110 degrees. It is understood that incisions must first be made in the soft tissue 55 surrounding the tibia 52 such that a tool may engage the tibia 52 and the femur 54 to form the tibial tunnel 56 and the femoral tunnel 58 .
- any suitable tool may produce the respective tunnels 56 , 58 such as a pneumatic or electric drill or reamer. It is also understood that the femoral tunnel 58 is a blind tunnel.
- a blind tunnel is a tunnel which includes an entrance but no discernable exit, rather a blind tunnel terminates below the surface of the femur 54 .
- the size of the tibial tunnel 56 and the femoral tunnel 58 depends upon the size of the soft tissue replacement (described further herein) to be implanted into the patient. The larger the replacement needed, the larger the diameter of the tibial tunnel 56 and the femoral tunnel 58 .
- the tibial tunnel 56 and femoral tunnel 58 may be of any required diameter, but are generally between about 5 and 18 millimeters. It would be understood, however, that if a larger diameter replacement is necessary, then larger diameter tunnels 56 , 58 may be produced in the tibia 52 and femur 54 to receive the implant. Additionally, smaller tunnels 56 , 58 may be used if only a smaller implant is necessary.
- the largest area of the insertion rod 26 will have a diameter substantially equal to the diameter of the tibial tunnel 56 and femoral tunnel 58 .
- the outside diameter of the guide portion 36 would be substantially equal to diameter of the tibial tunnel 56 and the femoral tunnel 58 .
- the body portion 28 may have a lesser diameter, or a taper towards the shoulder 41 , to ease insertion and removal of the insertion rod 26 . This ensures that the insertion rod 26 , and particularly the slot 42 , are substantially centered in the femoral tunnel 58 for the remaining procedure.
- a flexible strand 62 having a trailing end 62 a and a leading end 62 b , is placed or pre-loaded into the flexible strand groove 44 and then the insertion rod 26 is inserted through the tibial tunnel 56 and into the femoral tunnel 58 , as best shown in FIG. 4 (see also FIGS. 1 and 2 ).
- the flexible strand 62 may be any generally known strand suitable to the purpose such as a mono- or poly-filament suture, a flexible wire, or cord made of any suitable material.
- the flexible strand groove 44 allows the flexible strand 62 to be inserted through the tunnels 56 , 58 without engaging the walls of the tunnels 56 , 58 .
- the depth of the flexible strand groove 44 is at least equal to the diameter of the flexible strand 62 .
- the flexible strand 62 is placed so that it reaches substantially to the end of the femoral tunnel 58 and the slot 42 creates an opening through the center of the femoral tunnel 58 through which an instrument may pass, while not interrupting the flexible strand 62 which has been inserted into the femoral tunnel 58 by the insertion rod 26 .
- the flexible strand 62 is caught in the flexible strand notch 23 .
- the flexible strand 62 is held in position during the insertion of the insertion rod 26 into the tunnels 56 , 58 and during the remaining surgical procedure by the flexible strand notch 23 .
- Any suitable means may be used to hold the flexible strand 62 in place relative to the L-Guide member 12 of the apparatus 10 .
- the flexible strand notch 23 which holds the flexible strand 62 with friction, is merely exemplary of one appropriate means to hold the flexible strand 62 in place.
- a device such as a first drill bit or point 70 is used to produce a transverse tunnel 72 in the femur 54 .
- the transverse tunnel 72 is formed transversely to the femoral tunnel 58 by using the first guide section 18 .
- the second guide 19 is used to form a second transverse tunnel 73 using a second drill bit or point 71 .
- the transverse tunnel 72 will include an insertion point 72 a and an exit point 72 b .
- the drill points 70 and 71 may be powered by any appropriate device known in the art such as an electric or pneumatic drill.
- additional guide units or bullets 74 such as the U-Guide bullet produced by Arthotek, Inc. of Warsaw, Ind., may be used to ensure the proper orientation and depth of the drill points 70 and 71 .
- the guide bullet 74 is inserted into the guide sections 18 and 19 and held in place with the set screws 20 and 21 to ensure the drill points 70 and 71 are properly aligned with the slot 42 when producing the transverse tunnels 72 .
- the transverse tunnels 72 and 73 are produced through the entire width of the femur 54 so that the drill points 70 and 71 exits the femur 54 producing the exit points 72 b and 73 b . This allows the drill points 70 and 71 to be removed through the exit points 72 b and 73 at the appropriate time.
- a cannulated reamer (not shown) enlarges a portion of the transverse tunnel 72 .
- the reamed tunnel 75 receives the pin 84 (described herein). The reamed tunnel 75 does not extend the length of the transverse tunnel 72 .
- the second drill point 71 forms a removable suture bearing surface 76
- the first drill point 70 has a soft tissue bearing surface 77 .
- the apparatus 10 is removed as particularly shown in FIG. 6 .
- the drill point 70 remains in the transverse tunnel 72 .
- a soft tissue replacement 80 is affixed to the trailing end 62 a of the flexible strand 62 .
- the soft tissue replacement may be any suitable replacement such as a hamstring portion, an allograft tissue replacement, a xenograft tissue replacement, or an artificial soft tissue replacement which may be produced from materials such as polymers or metal.
- the leading end 62 b of the flexible strand 62 is pulled over the suture bearing surface 76 drawing the soft tissue replacement 80 first through the tibial tunnel 56 and then through the femoral tunnel 58 adjacent to and preferably over the first drill point 70 and up to the second drill point 71 .
- the second drill point and suture bearing surface 76 is removed and the flexible strand and soft tissue is pulled to pull the soft tissue over the first drill point 70 and associated soft tissue bearing surface 77 , back down the femoral tunnel 58 , and out through the tibial tunnel 56 .
- the drill point 70 generally includes an eyelet 86 which will allow the attachment of the pin 84 to the drill point 70 .
- the pin 84 is attached to the eyelet 86 through a second flexible strand 88 or other appropriate means.
- the drill point 70 is pulled through the transverse tunnel 72 , through the loop of the soft tissue replacement 80 and out the exit point 72 b . This pulls the pin 84 into position and fixes it within the transverse tunnel 72 , as particularly shown in FIG. 9 .
- the attached flexible strand 88 may be cut or otherwise disengaged from between the eyelet 86 and the pin 84 .
- the drill point 70 is then freely removed from the transverse tunnel 72 .
- the pin 84 may include a square end to hold pin 84 in place.
- the pin 84 may also be threaded such as the device described in U.S. Pat. No. 5,674,224 entitled “Bone Mulch Screw Assembly For Industrial Fixation of Soft Tissue Soft tissue replacements And Method For Using Same” to Stephen M. Howell et al. incorporated herein by reference.
- the second transverse tunnel 73 forms an aperture which can be used to inject biologic materials such as platelets, bone chips, or allograph materials into the tunnel 56 . Additionally, the second transverse passage 73 can be used to inject bone cement into the femoral tunnel 58 and about pin 84 .
- a staple 90 is used to affix the free ends 80 a and 80 b of the soft tissue replacement 80 to the tibia 52 , as best shown in FIG. 10 . It will be understood, however, that any appropriate means may be used to affix the free ends 80 a , 80 b to the tibia 52 such as U.S. Pat. No. 5,674,224 entitled “Bone Mulch Screw Assembly For Industrial Fixation of Soft Tissue Soft tissue replacements And Method For Using Same” to Stephen M.
- any appropriate means may be used to affix the soft tissue replacement 80 in the femoral tunnel 58 .
- the pin 84 is merely exemplary of any appropriate device to affix the soft tissue replacement 80 in the femoral tunnel 58 . Any commonly known screw or other fixation device may be used to fix the soft tissue replacement 80 in the femoral tunnel 58 .
- the soft tissue replacement 80 may be pulled over the pin 84 after the pin 84 has been lodged in the transverse tunnel 72 . In particular, if the pin 84 is smooth, the soft tissue replacement 80 may be pulled over the pin 84 without damaging the soft tissue replacement 80 itself. The drill point 70 is simply removed from the transverse tunnel 72 before the soft tissue replacement 80 is pulled into the femoral tunnel 58 .
- the method for performing the described procedure may be altered but remain within the scope of the presently claimed invention.
- the flexible strand 62 may looped over the insertion rod 26 such that the two free ends 62 a and 62 b are on one side and a loop of the flexible strand is formed on the other side of the insertion rod 26 .
- the soft tissue replacement 80 may be affixed to both free ends 62 a and 62 b or placed through the loop and then pulled over the insertion rod 26 .
- a prepared femur 120 is shown. Bored into the femur is a femoral tunnel 122 configured to accept an ACL 124 .
- the femoral tunnel 122 has a first portion 126 having a first diameter and a second portion 128 having a second diameter which is smaller than the first diameter.
- the second portion can be co-axial with the first portion.
- Disposed between the first and second portions is a locking cavity 130 .
- the locking cavity 130 is configured to provide a positive bearing surface 132 which, as described below, functions as a bearing surface for a locking member 134 .
- transverse tunnel 136 which is used for the introduction of biocompatible or biological materials.
- the materials can be injected into the femoral tunnel 122 through the transverse passage by the use of a syringe 38 or similarly configured injection device.
- the ACL 124 is coupled to a suture 140 , which is fed into the femoral tunnel 122 .
- the suture 140 can be fed directly though the femoral tunnel 122 , or can be inserted into the tunnel 122 using a guide rod (not shown).
- the ACL 124 is then pulled up through the femoral tunnel 122 to a point that the ACL 124 reaches the locking cavity 130 .
- the suture 140 can be equipped with indicia which will signal the physician when the ACL 124 has been drawn a sufficient distance into the femoral tunnel 122 so as to position a portion of the ACL 124 into the locking cavity 130 .
- liquid locking cement 142 is injected into the locking cavity through the transverse tunnel 136 so as to completely surround the ACL 124 and substantially fill the locking cavity 130 .
- this locking cement 142 is a fast curing cement which quickly hardens into a locking member 134 to lock the ACL 124 into the locking cavity 130 .
- the cement can include either morselized allograph materials, xenograft materials, platelets, synthetic bone cement, as well as other types of orthopedic graft materials such as a 50/50 CaP/CaS material and combinations thereof.
- the formed locking member 134 defines a pair of surfaces 144 which engage the bearing surfaces of the locking cavity.
- the locking cement 142 be of sufficient strength so that when the ACL 124 is axially loaded under normal loading, the ACL 124 does not become disconnected from the formed locking member 134 .
- the locking anchor member 134 is of sufficient strength so as to not to deform or fracture when loaded by the bearing surface 132 of the locking cavity 130 .
- the remainder of the ACL 124 is then formed into a canal formed in the tibia as is known in the art. The ACL 124 is then fixed to the tibia.
- FIGS. 16 a and 16 b represent another embodiment of the invention. Coupled to a suture 140 is a one piece cylindrical biocompatible anchor member 134 a .
- the anchor member 134 a defines an ACL coupling slot 146 , which functions as a hook to pull the ACL 124 into the locking cavity 130 .
- the anchor member 134 a further defines a suture retaining bore 148 passing through a portion of the cylindrical member 134 , the suture retaining bore 148 is operable to receive the mid-portion of the suture or flexible strand 140 .
- the locking member has a first profile or dimension which allows insertion of the locking member 134 through the femoral tunnel 122 and a second profile or dimension which allows engagement with the positive locking surface 132 upon rotation of the locking member 134 within the cavity 130 .
- the suture 140 is fed into and drawn up through the femoral tunnel 122 .
- the biocompatible anchor member 134 a and coupled ACL 124 is then pulled up through the femoral tunnel 122 to a point that the biocompatible locking member 34 a and accompanying ACL 124 reaches the locking cavity 130 .
- the locking member 134 a is then rotated within the locking cavity 130 so as to lock the ACL 24 into the locking cavity 130 .
- the locking member 134 a further defines a first curved bearing surface 150 which supports the ACL 124 when the anchor is in a first orientation 152 and a second bearing surface 154 which supports the soft tissue implant when the anchor has been rotated into a second locked orientation 156 .
- the locking member additionally defines a pair of bearing surfaces which engages the bearing surfaces of the locking cavity.
- liquid locking cement 142 may be optionally injected into the locking cavity 130 through the transverse passage 136 so as to completely surround the locking member 134 a and ACL 124 so as to partially fill the locking cavity.
- the locking member 134 a can have an optional through bore 153 which accepts and facilitates the flow of the liquid locking cement 142 to enhance the coupling of the ACL 124 .
- this locking cement 142 is a fast curing cement which quickly hardens into a structure to lock the locking member 134 a and ACL 124 into the locking cavity 130 .
- the locking member 134 can also be formed of bioresorbable material.
- bioresorbable materials typically in the form of various orthopedic devices, in connection with the treatment of various bone deformities, especially fractures, is well known in the art.
- These resorbable materials also referred to as bioresorbable, biodegradable, absorbable, and bioabsorbable devices, have enabled the medical community to achieve excellent surgical results, even under difficult clinical conditions.
- resorbable materials are generally as strong as conventional metallic materials and resorb into the body over a generally predictable time period once a sufficient level of healing has occurred, for example, at the junction of a bone fracture, thus negating the need for subsequent removal of the material.
- LACTOSORB® is an absorbable co-polymer synthesized from all-natural ingredients: 82% L-lactic acid and 18% glycolic acid, unlike the homopolymers in common use such as 100% poly-L-lactic acid (PLLA) or 100% polyglycolic acid (PGA), LACTOSORB® copolymer is substantially amorphous (i.e., without crystallinity), meaning that its degradation is uniform, precluding the crystalline release associated with degrading copolymers that have been associated with late inflammatory reactions. Furthermore, the LACTOSORB® copolymer ratio permits the polymer to retain most of it's strength for six to eight weeks, which is appropriate for healing, but not so long as to raise concerns about long-term stress shielding of bone.
- FIGS. 17 through 17 b represent another embodiment of the invention.
- the ACL anchor 134 b shown is specifically configured to draw the ACL 124 into the femoral tunnel 122 without causing interference between the ACL 124 and the sides of the tunnel.
- the ACL anchor 134 b has a saddle bearing surface 154 .
- the saddle bearing surface 154 defines a first seat 156 which bears the ACL while it is being drawn in to the femoral tunnel 122 .
- the saddle bearing surface 154 also defines a second bearing surface 158 , which functions as a bearing surface when then the locking member is rotated into its engaged position.
- the ACL locking anchor 134 b is coupled to a suture, which is fed into the femoral tunnel 122 .
- the ACL 124 is then pulled up through the femoral tunnel 122 to a point that the ACL 124 reaches the locking cavity 130 .
- the ACL 124 is coupled to the locking cavity by the introduction of bone cement through the transverse cavity.
- FIGS. 19 , 19 b , and 20 represent another embodiment of the invention.
- the ACL anchor 134 c defines a though passage 160 which accepts an ACL 124 therethrough. Additionally shown is a saddle bearing surface 162 .
- the through passage 160 defines a first seat 164 which bears the ACL while it is being drawn in to the femoral tunnel.
- the saddle bearing surface also defines a second bearing surface 166 , which functions as a bearing surface when then the locking member is rotated into its engaged position.
- FIG. 21 a represents an alternate method of coupling an ACL 124 into a femoral tunnel 128 .
- a cross pin 70 is positioned transverse to the tunnel 136 .
- the ACL 124 is now pulled over the cross pin 70 as previously described.
- the cross pin 70 has an exterior surface 200 which has a threaded portion 202 .
- the thread 202 is configured to threadably engage a nozzle portion 204 of a glue/bone cement injection gun 206 .
- the nozzle portion 204 has a forward internally threaded conical portion 208 that is fluidly coupled to a polymer mixing portion 210 .
- the nozzle portion 204 is coupled to the cement gun 206 using a threading coupling 212 .
- the cement gun 206 and corresponding nozzle portion 204 are coupled to the cross pin 70 and translated through the femur so as to cause the nozzle portion 204 to displace the cross pin 70 and support the ACL 124 within the tunnel 136 .
- the pin 70 can be rotated to decouple the pin 70 from the nozzle portion 204 .
- a trigger of the cement gun 206 is actuated to fill the tunnel 136 with bone cement or glue.
- the tunnel 136 is filled with cement or glue while the nozzle portion 204 is being retracted toward the bone cement gun 206 .
- the cement is allowed to set prior to fixation to the tibia.
Abstract
Description
- This application is a continuation of U.S. patent application Ser. No. 11/201,491 filed on Aug. 11, 2005, which is a continuation-in-part application of U.S. patent application Ser. No. 10/686,236 filed on Oct. 15, 2003, now U.S. Pat. No. 7,341,592 issued on Mar. 11, 2008. The disclosures of the above applications are incorporated herein by reference.
- The present invention relates to endoscopic soft tissue replacement fixation. More particularly, the present invention relates to an apparatus and a method to reconstruct an anterior cruciate ligament with soft tissue replacements within a femoral tunnel.
- The knee joint is frequently the object of injury and is often repaired using arthroscopic surgical procedures. An example of such arthroscopic surgical procedure is the replacement of anterior cruciate ligaments of the knee. The tearing of these ligaments is common in sports activities such as football or skiing.
- Currently, fascia lata soft tissue replacements are flexible strands which are affixed to a threaded stud and turned into the femoral tunnel. Unfortunately, this procedure may result in the soft tissue replacement being wrapped upon itself during insertion. Hamstring soft tissue replacements are also currently fixed over a screw in the tibial tunnel and fixed on the lateral femur. This technique requires the femoral tunnel to completely penetrate the femur. In addition, according to present procedures, fixation of the soft tissue replacement on the femoral side requires a large incision.
- It has been difficult to insert and fasten a soft tissue replacement in a blind hole or tunnel. Attempts have been made to thread the soft tissue replacement through the tunnel and over an anchor, but with some difficulty. Thus far, the prior art has not developed a quick and efficient way to implant a soft tissue replacement over an implanted anchoring system.
- While offering certain improvements in arthroscopic surgery to repair ligaments, the prior art may still be improved upon to overcome the limitations on the endoscopic hamstring soft tissue replacement fixation due, in many instances, to the weakness of the flexible strand used to span the gap between the tendon soft tissue replacement and the fixation post.
- Other techniques attempt to use biological fixation to augment or replace mechanical fixation. While increasing fixation strength these techniques require time to fully realize their fixation potential. Additionally the techniques may take additional surgical time and resources that a purely mechanical fixation technique may not require.
- An apparatus including a member that acts as a flexible strand insertion and guide rod is used to increase the simplicity and effectiveness of a soft tissue implant procedure. The member inserts a flexible strand, which has been preloaded onto the insertion rod, into a blind tunnel formed in a bone structure and provides a guide for first and second drill points or bits. Thus the member may be removed with the flexible strand already positioned in place to pull an implant into the blind tunnel over the first drill point and adjacent the second drill point. The second drill point is then removed, allowing the implant to be easily pulled over the first drill point. A cross or set pin is then pulled after the drill point into the drill hole to lock the implant in place.
- A first embodiment includes an apparatus to position a flexible strand in a tunnel, having a diameter, formed in a bone while performing a surgery. The apparatus comprises a guide member extending along a first axis and having a first end and second end. The guide member includes a guide portion defining an area, extending from the first end and along the first axis. The guide portion includes a first leg and a second leg, the first leg and the second leg define a slot disposed therebetween, wherein the slot defines a first plane. The first leg further defines a first groove and the second leg defines a second groove; wherein the first groove extends along a distal end of the first leg and along a length of the first leg and the second groove extends along a distal end of the second leg and along a length of the second leg. The first groove and the second groove are adapted to receive the flexible strand. The apparatus further has a second guide member fixed parallel to the first member. The second member has a pair of guide holes configured to guide first and second adjacent drill points.
- A second embodiment of the apparatus includes an apparatus to place a flexible strand in a tunnel, having a diameter, formed in bone while performing a surgery. The apparatus comprises a first member having a first end and a second end spaced apart. The first end defines a slot, adapted to guide an instrument, wherein the slot lies in a first plane. The first end further defines a groove, wherein the groove lies in a second plane. The first plane and the second plane intersect. A second member having a first end and a second end, the second member defines first and second passages positioned adjacent the first end. The first member extends adjacent to the second end of the second member; wherein the first end of the first member and the passage are generally aligned.
- The apparatus allows a method of performing an implant procedure. A method of surgically implanting a soft tissue replacement for attaching two bone members comprises inserting an insertion rod having a flexible strand pre-loaded on the insertion rod into a first tunnel. Next, forming second and third tunnels transverse and through the first tunnel and the insertion rod with a tool bit. Next, retaining the flexible strand within the first tunnel. The method also includes removing the insertion rod from the second tunnel and retracting the flexible strand.
- Further areas of applicability of the present invention will become apparent from the detailed description provided hereinafter. It should be understood that the detailed description and specific examples, while indicating the preferred embodiment of the invention, are intended for purposes of illustration only and are not intended to limit the scope of the invention.
- The present invention will become more fully understood from the detailed description and the accompanying drawings, wherein:
-
FIG. 1 is a perspective view of the bone insertion rod affixed to a U-Guide; -
FIG. 2 is a perspective view of bone insertion rod not affixed to the U-Guide; -
FIG. 3 is an exemplary view of a knee prepared for insertion of the insertion rod; -
FIG. 4 is a perspective view of the insertion rod and U-Guide inserted into the tibia and femur tunnels with the flexible strand in place; -
FIG. 5 is a view of the U-Guide and insertion rod in place with a pair of K-Wire Drill Points forming a transverse tunnel; -
FIG. 6 is perspective view of the first and second K-Wire Drill Points with the flexible strand affixed to a soft tissue replacement and draped over the second K-Wire Drill Point; -
FIG. 7 depicts the second K-Wire Drill Point removed with the soft tissue replacement draped over the first K-Wire Drill Point; -
FIG. 8 is a perspective view of the soft tissue replacement pulled over the K-Wire and out through the tibial tunnel; -
FIG. 9 is a perspective view of the soft tissue replacement in place and the ACL Cross Pin set in place in the transverse tunnel in the femur; and -
FIG. 10 is a view of the knee with an ACL replacement having its free ends affixed to the tibia and the femoral end affixed over the ACL Cross Pin. -
FIG. 11 represents the insertion of bone cement into the femoral tunnel shown inFIG. 1 ; -
FIG. 12 is a view of a knee joint having a prepared femur accordance to the teachings of an embodiment the present invention; -
FIGS. 12 and 13 represent the insertion of the soft tissue into a femoral tunnel shown inFIG. 10 ; -
FIGS. 13 and 14 represent the insertion of a soft tissue implant according to the teachings of a second embodiment of the invention; -
FIG. 15 represents the insertion of bone cement into the femoral tunnel shown inFIG. 12 ; -
FIGS. 16 a through 16 d represent the insertion of a soft tissue implant according to another embodiment of the invention; -
FIGS. 17 a and 17 b represent side and end views of a soft tissue implant according to the teachings of the present invention; -
FIG. 18 represents the insertion of soft tissue using a soft tissue implant shown inFIGS. 17 a and 17 b; -
FIGS. 19 a and 19 b represent alternate soft tissue implants according to another embodiment of the present invention; -
FIG. 20 represents an alternate method of coupling an ACL into a femoral tunnel; and -
FIGS. 21 a and 22 represent an alternate method of coupling an ACL into a femoral tunnel. - The following description of the embodiments is merely exemplary in nature and is in no way intended to limit the invention, its application, or uses. Moreover, while the present invention is discussed in detail below with regard to ACL reconstruction, those skilled in the art will recognize the other types of soft tissue fixation may employ the present invention.
- Referring to
FIG. 1 , aguide apparatus 10, which may be generally U-shaped, includes an L-shaped retaining bar or L-guide 12 that includes two portions or legs, afirst portion 14 and asecond portion 16, that is substantially perpendicular to thefirst portion 14. Thefirst portion 14 defines afirst guide section 18 and asecond guide section 19, formed transversely through thefirst portion 14. The guide section may be passage through or transverse to thefirst portion 14 such as a bore wherein the guide section ledge would be a bore ledge. A pair ofset screws guide sections second portion 16 defines abore 22 formed transversely through thesecond portion 16. Aset screw 24 is also provided to create a locking mechanism for thebore 22. The L-guide 12 is shown in an L-shape, however, it will be understood the L-guide 12 may be any appropriate form. Generally, however, the axes defining theguide section 18 and thebore 22 are orthogonal. Therefore, the first and second axis A and B of theguide section 18 should intersect the second axis E of thebore 22 at a right angle. - An insertion or guide
rod 26 is adjustably held in thebore 22 and locked in place with theset screw 24. With continuing reference toFIG. 1 and further reference toFIG. 2 , theinsertion rod 26 includes abody portion 28. Thebody portion 28 is substantially cylindrical and formed around a longitudinal axis C. Thebody portion 28, which is generally a solid, may also taper towards the guide portion 36 (described herein). Also, thebody portion 28 may includedepth indicia 29 to give a visual indication of the depth of theinsertion rod 26 into a patient. - Extending from a first end of the
body portion 28 is an L-Guide engaging portion 30 which includes a notch orprojection 32 that is received in thesecond portion 16 of the L-Guide 12 to ensure proper orientation of theinsertion rod 26 to the L-Guide 12. Thenotch 32 on theinsertion rod 26 is keyed to be received on to a portion of thesecond portion 16. Theinsertion rod 26 further includes acollar 34, to ensure that theinsertion rod 26 is held at a predetermined depth in the L-Guide 12 and to further ensure proper orientation of theinsertion rod 26 relative to the L-Guide 12. - A
guide portion 36 extends from a second end of thebody portion 28. Theguide portion 36 includes two generallyparallel legs shoulder 41. Eachleg body portion 28 along axis C, though offset therefrom. The twolegs slot 42, where theslot 42 extends substantially the distance of the twolegs shoulder 41. Also formed in each of thelegs flexible strand groove 44. Theflexible strand groove 44 may be any appropriate depth, but exemplary is substantially equal in depth to the diameter of a cord or flexible strand thread or suture to be used with theapparatus 10. - The
insertion rod 26 may be any desired length. Preferably, however, the distance between thecollar shoulder 34 and theshoulder 41 is equal to the distance between a first end of thefirst portion 14, generally represented by line D, and theguide section 19. In this way, theguide section ledge 19 and theslot 42 are generally equidistant from thesecond portion 16. Therefore, any instrument received through theguide section 19 would remain substantially parallel to thesecond portion 16 when it passed through theslot 42. - The
flexible strand groove 44 is placed orthogonally to theslot 42 so that a cord, such as a flexible strand, may be placed in theflexible strand groove 44 to form an enclosed passage for any device that may be placed through theslot 42. In this way, a device such as a K-Wire (described herein), when inserted through theslot 42 has a flexible strand looped over the K-Wire. It will be understood, however, that theflexible strand groove 44 may be formed at any orientation relative to theslot 42 as long as a flexible strand placed in theflexible strand groove 44 will overlay theslot 42. - The
notch 32 ensures that theinsertion rod 26 is properly oriented with the L-Guide member 12 of theU-guide apparatus 10. In particular, theslot 42 is preferably aligned with theguide sections set screw 24 tightens against the L-Guide engaging portion 30 to ensure that theinsertion rod 26 does not move during a surgical procedure. Also, this ensures the proper keyed fit of thenotch 32 into thesecond portion 16 so that theguide section 18 and theslot 42 are properly aligned. This ensures that the instrument received through theapparatus 10 is aligned. It will be understood, however, that any appropriate means may be used to secure theinsertion rod 26 to the L-Guide member 12 of theapparatus 10. - Referring to the remaining
FIGS. 3-11 , an exemplary method for using theapparatus 10, including theinsertion rod 26 is described. It will be understood that although theapparatus 10 is described in the use of an Anterior Cruciate Ligament (ACL) replacement, any appropriate surgery may be performed with theapparatus 10 which would require its attributes. - With particular reference to
FIG. 3 , aknee 50 generally includes at least atibia 52 and afemur 54 surrounded by soft tissue 55. Theknee 50 is initially prepared by forming atibial tunnel 56 and afemoral tunnel 58 which are substantially in line with one another such that a straight and solid object could engage both thetibial tunnel 56 and thefemoral tunnel 58 without a substantial amount of stress when the knee is placed in flexion between about 30 degrees and 110 degrees. It is understood that incisions must first be made in the soft tissue 55 surrounding thetibia 52 such that a tool may engage thetibia 52 and thefemur 54 to form thetibial tunnel 56 and thefemoral tunnel 58. Any suitable tool may produce therespective tunnels femoral tunnel 58 is a blind tunnel. A blind tunnel is a tunnel which includes an entrance but no discernable exit, rather a blind tunnel terminates below the surface of thefemur 54. - The size of the
tibial tunnel 56 and thefemoral tunnel 58 depends upon the size of the soft tissue replacement (described further herein) to be implanted into the patient. The larger the replacement needed, the larger the diameter of thetibial tunnel 56 and thefemoral tunnel 58. Thetibial tunnel 56 andfemoral tunnel 58 may be of any required diameter, but are generally between about 5 and 18 millimeters. It would be understood, however, that if a larger diameter replacement is necessary, thenlarger diameter tunnels tibia 52 andfemur 54 to receive the implant. Additionally,smaller tunnels insertion rod 26 will have a diameter substantially equal to the diameter of thetibial tunnel 56 andfemoral tunnel 58. For example, if theinsertion rod 26 was produced so that theguide portion 36, in particular theshoulder 41, form the largest diameter of theinsertion rod 26, then the outside diameter of theguide portion 36 would be substantially equal to diameter of thetibial tunnel 56 and thefemoral tunnel 58. Also, thebody portion 28 may have a lesser diameter, or a taper towards theshoulder 41, to ease insertion and removal of theinsertion rod 26. This ensures that theinsertion rod 26, and particularly theslot 42, are substantially centered in thefemoral tunnel 58 for the remaining procedure. - A
flexible strand 62, having a trailingend 62 a and aleading end 62 b, is placed or pre-loaded into theflexible strand groove 44 and then theinsertion rod 26 is inserted through thetibial tunnel 56 and into thefemoral tunnel 58, as best shown inFIG. 4 (see alsoFIGS. 1 and 2 ). Theflexible strand 62 may be any generally known strand suitable to the purpose such as a mono- or poly-filament suture, a flexible wire, or cord made of any suitable material. Theflexible strand groove 44 allows theflexible strand 62 to be inserted through thetunnels tunnels flexible strand groove 44 is at least equal to the diameter of theflexible strand 62. Theflexible strand 62 is placed so that it reaches substantially to the end of thefemoral tunnel 58 and theslot 42 creates an opening through the center of thefemoral tunnel 58 through which an instrument may pass, while not interrupting theflexible strand 62 which has been inserted into thefemoral tunnel 58 by theinsertion rod 26. Theflexible strand 62 is caught in theflexible strand notch 23. Theflexible strand 62 is held in position during the insertion of theinsertion rod 26 into thetunnels flexible strand notch 23. Any suitable means may be used to hold theflexible strand 62 in place relative to the L-Guide member 12 of theapparatus 10. Theflexible strand notch 23, which holds theflexible strand 62 with friction, is merely exemplary of one appropriate means to hold theflexible strand 62 in place. - Referring generally to
FIG. 5 , once theinsertion rod 26 has been inserted into thefemoral tunnel 58, so that theflexible strand 62 is positioned properly, a device, such as a first drill bit orpoint 70 is used to produce atransverse tunnel 72 in thefemur 54. Thetransverse tunnel 72 is formed transversely to thefemoral tunnel 58 by using thefirst guide section 18. Thesecond guide 19 is used to form a secondtransverse tunnel 73 using a second drill bit orpoint 71. Thetransverse tunnel 72 will include aninsertion point 72 a and an exit point 72 b. It will be understood that an incision must first be made in the soft tissue 55 surrounding thefemur 54, so that the drill bit or points 70 and 71 may engage thefemur 54 to form thetransverse tunnel 72. The drill points 70 and 71 may be powered by any appropriate device known in the art such as an electric or pneumatic drill. Furthermore, additional guide units orbullets 74, such as the U-Guide bullet produced by Arthotek, Inc. of Warsaw, Ind., may be used to ensure the proper orientation and depth of the drill points 70 and 71. Theguide bullet 74 is inserted into theguide sections set screws slot 42 when producing thetransverse tunnels 72. - The
transverse tunnels femur 54 so that the drill points 70 and 71 exits thefemur 54 producing the exit points 72 b and 73 b. This allows the drill points 70 and 71 to be removed through the exit points 72 b and 73 at the appropriate time. While theapparatus 10 is still in place, a cannulated reamer (not shown) enlarges a portion of thetransverse tunnel 72. The reamedtunnel 75 receives the pin 84 (described herein). The reamedtunnel 75 does not extend the length of thetransverse tunnel 72. Thesecond drill point 71 forms a removable suture bearing surface 76, while thefirst drill point 70 has a soft tissue bearing surface 77. - After the reamed
tunnel 75 is produced, theapparatus 10, is removed as particularly shown inFIG. 6 . Once theapparatus 10 has been removed, thedrill point 70 remains in thetransverse tunnel 72. Asoft tissue replacement 80 is affixed to the trailingend 62 a of theflexible strand 62. The soft tissue replacement may be any suitable replacement such as a hamstring portion, an allograft tissue replacement, a xenograft tissue replacement, or an artificial soft tissue replacement which may be produced from materials such as polymers or metal. - As shown in
FIG. 7 , after thesoft tissue replacement 80 has been affixed to the trailingend 62 a, the leadingend 62 b of theflexible strand 62 is pulled over the suture bearing surface 76 drawing thesoft tissue replacement 80 first through thetibial tunnel 56 and then through thefemoral tunnel 58 adjacent to and preferably over thefirst drill point 70 and up to thesecond drill point 71. At this point, the second drill point and suture bearing surface 76 is removed and the flexible strand and soft tissue is pulled to pull the soft tissue over thefirst drill point 70 and associated soft tissue bearing surface 77, back down thefemoral tunnel 58, and out through thetibial tunnel 56. This produces a loop of thesoft tissue replacement 80 over the soft tissue bearing surface 77 of thefirst drill point 70 inside of thefemoral tunnel 58. After being looped over thefirst drill point 70, the two free ends 80 a and 80 b of thesoft tissue replacement 80 extend from thetibial tunnel 56 adjacent to thetibia 52. - After the
soft tissue replacement 80 has been looped over thefirst drill point 70, an ACL cross pin orpin 84 is pulled into place in the reamedtunnel 75. Thedrill point 70 generally includes aneyelet 86 which will allow the attachment of thepin 84 to thedrill point 70. Generally, thepin 84 is attached to theeyelet 86 through a secondflexible strand 88 or other appropriate means. After thepin 84 is attached to theeyelet 86, thedrill point 70 is pulled through thetransverse tunnel 72, through the loop of thesoft tissue replacement 80 and out the exit point 72 b. This pulls thepin 84 into position and fixes it within thetransverse tunnel 72, as particularly shown inFIG. 9 . Once thepin 84 has been fixed in place in thetransverse tunnel 72, the attachedflexible strand 88 may be cut or otherwise disengaged from between theeyelet 86 and thepin 84. Thedrill point 70 is then freely removed from thetransverse tunnel 72. This leaves thepin 84 lodged into thetransverse tunnel 72 which may be locked in place with either portions of thepin 84 or through any other appropriate locking means. Although any appropriate means may be used to holdpin 84 in the reamedtunnel 75, thepin 84 may include a square end to holdpin 84 in place. Thepin 84 may also be threaded such as the device described in U.S. Pat. No. 5,674,224 entitled “Bone Mulch Screw Assembly For Industrial Fixation of Soft Tissue Soft tissue replacements And Method For Using Same” to Stephen M. Howell et al. incorporated herein by reference. - As shown in
FIG. 10 , the secondtransverse tunnel 73 forms an aperture which can be used to inject biologic materials such as platelets, bone chips, or allograph materials into thetunnel 56. Additionally, the secondtransverse passage 73 can be used to inject bone cement into thefemoral tunnel 58 and aboutpin 84. - Because the
pin 84 has been lodged in thetransverse tunnel 72, and thesoft tissue replacement 80 is looped over thepin 84, only the free ends 80 a and 80 b need to be secured to thetibia 52 to complete the implantation. A staple 90 is used to affix the free ends 80 a and 80 b of thesoft tissue replacement 80 to thetibia 52, as best shown inFIG. 10 . It will be understood, however, that any appropriate means may be used to affix the free ends 80 a, 80 b to thetibia 52 such as U.S. Pat. No. 5,674,224 entitled “Bone Mulch Screw Assembly For Industrial Fixation of Soft Tissue Soft tissue replacements And Method For Using Same” to Stephen M. Howell et al.; U.S. Pat. No. 6,280,472 B1 entitled “Apparatus And Method For Tibial Fixation Of Soft Tissue” to James A. Boucher et al.; and U.S. Pat. No. 5,931,869 entitled “Apparatus And Method For Tibial Fixation Of Soft Tissue” to James A. Boucher et al. each incorporated herein by reference. Once the free ends 80 a and 80 b of thesoft tissue replacement 80 are affixed to thetibia 52, thesoft tissue replacement 80 securely attaches thetibia 52 and thefemur 54 substantially as a natural ACL would. - It will be understood that any appropriate means may be used to affix the
soft tissue replacement 80 in thefemoral tunnel 58. Thepin 84 is merely exemplary of any appropriate device to affix thesoft tissue replacement 80 in thefemoral tunnel 58. Any commonly known screw or other fixation device may be used to fix thesoft tissue replacement 80 in thefemoral tunnel 58. It will also be understood that thesoft tissue replacement 80 may be pulled over thepin 84 after thepin 84 has been lodged in thetransverse tunnel 72. In particular, if thepin 84 is smooth, thesoft tissue replacement 80 may be pulled over thepin 84 without damaging thesoft tissue replacement 80 itself. Thedrill point 70 is simply removed from thetransverse tunnel 72 before thesoft tissue replacement 80 is pulled into thefemoral tunnel 58. - It will also be understood that the method for performing the described procedure may be altered but remain within the scope of the presently claimed invention. For example the
flexible strand 62 may looped over theinsertion rod 26 such that the twofree ends insertion rod 26. Thus thesoft tissue replacement 80 may be affixed to both free ends 62 a and 62 b or placed through the loop and then pulled over theinsertion rod 26. - Referring to
FIG. 12 , aprepared femur 120 is shown. Bored into the femur is afemoral tunnel 122 configured to accept anACL 124. Thefemoral tunnel 122 has afirst portion 126 having a first diameter and asecond portion 128 having a second diameter which is smaller than the first diameter. The second portion can be co-axial with the first portion. Disposed between the first and second portions is alocking cavity 130. The lockingcavity 130 is configured to provide apositive bearing surface 132 which, as described below, functions as a bearing surface for a lockingmember 134. - Generally perpendicular to the femoral tunnel is a
transverse tunnel 136 which is used for the introduction of biocompatible or biological materials. As further described below, the materials can be injected into thefemoral tunnel 122 through the transverse passage by the use of asyringe 38 or similarly configured injection device. - As shown in
FIGS. 14 and 15 , theACL 124 is coupled to asuture 140, which is fed into thefemoral tunnel 122. Thesuture 140 can be fed directly though thefemoral tunnel 122, or can be inserted into thetunnel 122 using a guide rod (not shown). TheACL 124 is then pulled up through thefemoral tunnel 122 to a point that theACL 124 reaches the lockingcavity 130. It is envisioned that thesuture 140 can be equipped with indicia which will signal the physician when theACL 124 has been drawn a sufficient distance into thefemoral tunnel 122 so as to position a portion of theACL 124 into the lockingcavity 130. - As best seen in
FIG. 15 ,liquid locking cement 142 is injected into the locking cavity through thetransverse tunnel 136 so as to completely surround theACL 124 and substantially fill thelocking cavity 130. It is envisioned that this lockingcement 142 is a fast curing cement which quickly hardens into a lockingmember 134 to lock theACL 124 into the lockingcavity 130. Additionally, the cement can include either morselized allograph materials, xenograft materials, platelets, synthetic bone cement, as well as other types of orthopedic graft materials such as a 50/50 CaP/CaS material and combinations thereof. The formed lockingmember 134 defines a pair ofsurfaces 144 which engage the bearing surfaces of the locking cavity. - It is further envisioned that the locking
cement 142 be of sufficient strength so that when theACL 124 is axially loaded under normal loading, theACL 124 does not become disconnected from the formed lockingmember 134. Further, the lockinganchor member 134 is of sufficient strength so as to not to deform or fracture when loaded by the bearingsurface 132 of thelocking cavity 130. After thecement 142 is cured, the remainder of theACL 124 is then formed into a canal formed in the tibia as is known in the art. TheACL 124 is then fixed to the tibia. -
FIGS. 16 a and 16 b represent another embodiment of the invention. Coupled to asuture 140 is a one piece cylindricalbiocompatible anchor member 134 a. Theanchor member 134 a defines anACL coupling slot 146, which functions as a hook to pull theACL 124 into the lockingcavity 130. Theanchor member 134 a further defines a suture retaining bore 148 passing through a portion of thecylindrical member 134, the suture retaining bore 148 is operable to receive the mid-portion of the suture orflexible strand 140. The locking member has a first profile or dimension which allows insertion of the lockingmember 134 through thefemoral tunnel 122 and a second profile or dimension which allows engagement with thepositive locking surface 132 upon rotation of the lockingmember 134 within thecavity 130. - As shown in
FIGS. 16 b-16 d, thesuture 140 is fed into and drawn up through thefemoral tunnel 122. Thebiocompatible anchor member 134 a and coupledACL 124 is then pulled up through thefemoral tunnel 122 to a point that the biocompatible locking member 34 a and accompanyingACL 124 reaches the lockingcavity 130. Generally, the lockingmember 134 a is then rotated within the lockingcavity 130 so as to lock theACL 24 into the lockingcavity 130. The lockingmember 134 a further defines a firstcurved bearing surface 150 which supports theACL 124 when the anchor is in afirst orientation 152 and asecond bearing surface 154 which supports the soft tissue implant when the anchor has been rotated into a second lockedorientation 156. The locking member additionally defines a pair of bearing surfaces which engages the bearing surfaces of the locking cavity. - As best seen in
FIG. 16 d, liquid lockingcement 142 may be optionally injected into the lockingcavity 130 through thetransverse passage 136 so as to completely surround the lockingmember 134 a andACL 124 so as to partially fill the locking cavity. The lockingmember 134 a can have an optional through bore 153 which accepts and facilitates the flow of theliquid locking cement 142 to enhance the coupling of theACL 124. As previously mentioned, it is envisioned that this lockingcement 142 is a fast curing cement which quickly hardens into a structure to lock the lockingmember 134 a andACL 124 into the lockingcavity 130. - The locking
member 134 can also be formed of bioresorbable material. The use of various resorbable materials, typically in the form of various orthopedic devices, in connection with the treatment of various bone deformities, especially fractures, is well known in the art. These resorbable materials also referred to as bioresorbable, biodegradable, absorbable, and bioabsorbable devices, have enabled the medical community to achieve excellent surgical results, even under difficult clinical conditions. - The main benefit of using resorbable materials is that they are generally as strong as conventional metallic materials and resorb into the body over a generally predictable time period once a sufficient level of healing has occurred, for example, at the junction of a bone fracture, thus negating the need for subsequent removal of the material.
- One exemplary resorbable material of particular interest is marketed by Biomet, Inc. (Warsaw, Ind.) under the tradename LACTOSORB®. LACTOSORB® is an absorbable co-polymer synthesized from all-natural ingredients: 82% L-lactic acid and 18% glycolic acid, unlike the homopolymers in common use such as 100% poly-L-lactic acid (PLLA) or 100% polyglycolic acid (PGA), LACTOSORB® copolymer is substantially amorphous (i.e., without crystallinity), meaning that its degradation is uniform, precluding the crystalline release associated with degrading copolymers that have been associated with late inflammatory reactions. Furthermore, the LACTOSORB® copolymer ratio permits the polymer to retain most of it's strength for six to eight weeks, which is appropriate for healing, but not so long as to raise concerns about long-term stress shielding of bone.
-
FIGS. 17 through 17 b represent another embodiment of the invention. TheACL anchor 134 b shown is specifically configured to draw theACL 124 into thefemoral tunnel 122 without causing interference between theACL 124 and the sides of the tunnel. TheACL anchor 134 b has asaddle bearing surface 154. Thesaddle bearing surface 154 defines afirst seat 156 which bears the ACL while it is being drawn in to thefemoral tunnel 122. Thesaddle bearing surface 154 also defines asecond bearing surface 158, which functions as a bearing surface when then the locking member is rotated into its engaged position. - As previously described above and as shown in
FIG. 9 c, theACL locking anchor 134 b is coupled to a suture, which is fed into thefemoral tunnel 122. TheACL 124 is then pulled up through thefemoral tunnel 122 to a point that theACL 124 reaches the lockingcavity 130. Optionally, theACL 124 is coupled to the locking cavity by the introduction of bone cement through the transverse cavity. -
FIGS. 19 , 19 b, and 20 represent another embodiment of the invention. TheACL anchor 134 c defines a thoughpassage 160 which accepts anACL 124 therethrough. Additionally shown is asaddle bearing surface 162. The throughpassage 160 defines afirst seat 164 which bears the ACL while it is being drawn in to the femoral tunnel. The saddle bearing surface also defines asecond bearing surface 166, which functions as a bearing surface when then the locking member is rotated into its engaged position. -
FIG. 21 a represents an alternate method of coupling anACL 124 into afemoral tunnel 128. After preparing thetransverse tunnel 136 in the femur, across pin 70 is positioned transverse to thetunnel 136. TheACL 124 is now pulled over thecross pin 70 as previously described. Thecross pin 70 has anexterior surface 200 which has a threadedportion 202. Thethread 202 is configured to threadably engage a nozzle portion 204 of a glue/bonecement injection gun 206. In this regard, the nozzle portion 204 has a forward internally threadedconical portion 208 that is fluidly coupled to apolymer mixing portion 210. The nozzle portion 204 is coupled to thecement gun 206 using athreading coupling 212. - As shown in
FIGS. 21 b and 22, thecement gun 206 and corresponding nozzle portion 204 are coupled to thecross pin 70 and translated through the femur so as to cause the nozzle portion 204 to displace thecross pin 70 and support theACL 124 within thetunnel 136. At this point, thepin 70 can be rotated to decouple thepin 70 from the nozzle portion 204. - To fixably couple the
ACL 124 into thetunnel 136, a trigger of thecement gun 206 is actuated to fill thetunnel 136 with bone cement or glue. In this regard, thetunnel 136 is filled with cement or glue while the nozzle portion 204 is being retracted toward thebone cement gun 206. As previously described, the cement is allowed to set prior to fixation to the tibia. - The description of the invention is merely exemplary in nature and, thus, variations that do not depart from the gist of the invention are intended to be within the scope of the invention. Such variations are not to be regarded as a departure from the spirit and scope of the invention.
Claims (9)
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US8226716B2 (en) * | 2001-03-13 | 2012-07-24 | Depuy Mitek, Inc. | Method and apparatus for fixing a graft in a bone tunnel |
US8449612B2 (en) | 2009-11-16 | 2013-05-28 | Arthrocare Corporation | Graft pulley and methods of use |
US8900301B2 (en) | 2007-03-13 | 2014-12-02 | Biomet Sports Medicine, Llc | Method and apparatus for graft fixation |
WO2015057866A1 (en) * | 2013-10-15 | 2015-04-23 | Si-Bone Inc. | Implant placement |
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US7896917B2 (en) | 2011-03-01 |
US8784489B2 (en) | 2014-07-22 |
US20050273003A1 (en) | 2005-12-08 |
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